Young, Married, and Powerful: Supporting First-time Parents and Young Married Women

Preventing Adolescent Pregnancy

Olivia Moseley

Pathfinder | Technical Advisor for Health & Rights Education
Young mothers with their children in Burkina Faso.

Young mothers with their children in Burkina Faso. Photo: Célestin Compaore.

In middle- and low-income countries, about 90% of births to adolescents occur within marriage or a union. Many of these young women are under substantial pressure from in-laws and other gatekeepers to begin childbearing immediately and to space their births closely, and service providers often reinforce these assumptions—all resulting in poorer health outcomes and less autonomy for young women. For years, programmatic and policy efforts have focused on preventing early and child marriage, but have paid little attention to adolescents after they marry or have children.

We know, however, that many of these young couples would like to delay and/or space their births—about one-third of married adolescents in sub-Saharan Africa say that they want to avoid a pregnancy in the next 2 years, but 67% of these are not using any contraceptive method. For the past two decades, Pathfinder International has been developing interventions and generating evidence focused on increasing access to and use of contraception among these underserved populations—reaching more than 692,000 married adolescents across seven countries. And, in recent years, we’ve seen donors and other organizations also increase efforts to reach first-time parents and young married women. As a community of public health practitioners, we can better serve these populations by learning from one another, sharing tools and resources, and applying these best practices.

Pathfinder recently collaborated with its USAID-funded Evidence to Action (E2A) project to build a new Toolkit on the K4Health platform. This Toolkit brings together a collection of high-quality tools that support program designers, implementers, donors, and policy makers to advance the health and rights of these underserved groups. It aims to expand and improve programming and services that help young married women and first-time parents access contraception, make informed decisions about their fertility and reproductive health, negotiate healthy relationships, prevent gender-based violence, and enjoy their right to a healthy sexual and reproductive life.

23-year-old Sudari Gorna (of the Gameti tribe) with her daughter Krishna.

23-year-old Sudari Gorna (of the Gameti tribe) with her daughter Krishna. Photo: Simon de Trey-White.

The Toolkit contains a diverse range of resources created by Pathfinder, E2A, and over 20 other organizations—from essential evidence to case studies sharing implementation experience around the world, training materials for health workers, and job aids and tools that support service delivery. Some of the resources are global, while others are context-specific.

During a recent webinar introducing the Toolkit, we explored the ways these tools can be adapted to fit different needs. For example, E2A and Pathfinder adapted and translated a set of training materials originally designed for Burkina Faso into Swahili to be appropriate for communities in Tanzania. “Translating” this Toolkit involved more than just translating the text—names were changed and stories had to be re-created to make sense in a Tanzanian context. Whereas in Burkina Faso most adolescent pregnancy happens in the context of marriage, most first-time parents in the targeted communities in Tanzania were unmarried, which required additional adaptation to training on counseling approaches, role plays, and group activities.

Making these adaptations is an investment—but it pays off. Project participants agreed that the interventions enhanced the ability of community health workers and facility-based providers to provide contraceptive services that are responsive to the needs and circumstances of young first-time mothers. Peer leaders facilitated linkages between the providers and the young clients, and all community health workers and providers said they observed an increase in the number of young clients seeking contraceptive services. (Learn more about this project.)

The Toolkit will grow with time (submissions welcome!) and will be updated regularly to ensure the resources remain accurate and relevant. Explore the new Meeting the Sexual and Reproductive Health Needs of Young Married Women and First-time Parents Toolkit.